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Neonatal Skin Structure and Function Second Edition, Revised and Expanded edited by Steven B. Hoath University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio, U.S.A. Howard I. Maibach University of California, San Francisco, School of Medicine San Francisco, California, U.S.A. MARCEL MARCELDEKKER, INC. NEWYORK - BASEL DEKKER First edition: Neonatal Skin: Structure and Function, Howard I. Maibach, Edward K. Boisits, eds., 1982. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress. ISBN: 0-8247-0887-3 This book is printed on acid-free paper. Headquarters Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016 tel: 212-696-9000; fax: 212-685-4540 Eastern Hemisphere Distribution Marcel Dekker AG Hutgasse 4, Postfach 812, CH-4001 Basel, Switzerland tel: 41-61-260-6300; fax: 41-61-260-6333 World Wide Web http://www.dekker.com The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the headquarters address above. Copyright # 2003 by Marcel Dekker, Inc. All Rights Reserved. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Current printing (last digit): 10987654321 PRINTED IN THE UNITED STATES OF AMERICA Preface to the Second Edition Over two decades have passed since publication of the first edition of Neonatal Skin: Structure and Function. During this time, sweeping changes have occurred in all aspects of healthcare, from the molecular diagnosis of disease to the advent of the Internet. In this climate of explosive change, the second edition of Neonatal Skin seeks to illuminate a topic both scientifically complex and aesthetically compelling—the skin of the newborn human infant. It is our belief that this topic deserves careful study and quantitative attention. It is toward this goal that this book was written. The picture that emerges from the study of newborn skin is unexpect- edly complex. The migration of melanocytes into the epidermis, the parti- cipation of the pilosebaceous apparatus in the development of the epidermal permeability barrier, and the production of a complex proteolipid skin ‘‘cream,’’ the vernix caseosa, all occur in utero. These fetal developments presage the abrupt transition to extrauterine life marked by birth. In mam- mals, few events are as transformative as the moment of birth. Certainly, no organ is more suddenly exposed to the exigencies and extremes of the exter- nal environment than the skin. Postnatally, the skin surface becomes rapidly colonized with selected microorganisms. It undergoes a complex process of surface acidification and interacts with a variety of environmental agents, including cleansers, drugs, and adhesives. Temperature control becomes a new and vital function requiring not only a barrier to transepidermal water loss but also an active system of eccrine sweating and vasomotor control. Not least in the rich panoply of functions subserved by the skin of the newborn is its ability to evoke emotional attachment and physical connec- tivity in adults. Aesthetically, newborn skin serves to beckon caregivers, thereby providing an apparent teleological reason for its being. iii iv Preface to the Second Edition This edition of Neonatal Skin seeks to summarize and interweave these multiple functions and their cutaneous support structures into a coherent scientific pattern. Our guiding belief is that the study and story of newborn skin are only now beginning to be articulated. The true functions of skin are at the highest level of biological organization (1). It is common knowledge, for example, that the evolutionary features which most clearly distinguish humans from other primates are, first and foremost, a large and versatile central nervous system and, second, a vulnerable and relatively hairless skin surface (2). The brain and the epidermis share a common ectodermal origin, and the skin and the brain are inextricably linked in everyday life at the level of perception. We anticipate growing interest in these complex areas of skin structure and function. As Aristotle is purported to have said, ‘‘He who sees things from their beginnings will have the clearest view of them.’’ It is in this spirit that the authors have collaborated to produce this second edition. Steven B. Hoath Howard I. Maibach REFERENCES 1. Chuong CM, Nickoloff BJ, Elias PM, et al. What is the ‘‘true’’ function of skin? Exp Dermatol 2002; 11:159–187. 2. Morris D. The Naked Ape: A Zoologist’s Study of the Human Animal. New York: Random House, 1999 (paperback edition). Preface to the First Edition Neonatal human skin is taken very much for granted. It is so soft, so smooth, and so perfect! Unfortunately, until recently, there has been little systematic study of its structure and function. This volume summarizes previous experience as well as considerable new information. The book starts with a complete description of the histology and ultrastructure of neonatal skin. Next, Drs. Green and Pochi delineate the structure and function of neonatal skin appendages: the eccrine and sebac- eous glands. Noninvasive techniques utilized to determine aspects of skin function in the neonate are discussed in Chapters 4–9. The techniques include determination of transepidermal water loss, carbon dioxide emission rates, and oxygen diffusion. These chapters define not only the relevant physiology, but current information on the advantages and limitations of today’s technology. The next two chapters review knowledge of the quantitative aspects of percutaneous penetration in relation to current data in adults. Neonatal cutaneous microbiology with regard to normal and diseased skin is then summarized by Drs. Leyden, Aly, and associates. The cutaneous dermatotoxicology section includes diaper dermatitis, allergic contact dermatitis in children, and the complex factors involved in diaper and plastic occlusion. In the final chapter, a concise overview of neonatal cutaneous disorders is provided. Hopefully, this summary will stimulate further investigation. There is much to learn. Howard I. Maibach Edward K. Boisits v Contents Preface to the Second Edition iii Preface to the First Edition v Contributors ix 1. Skin Structural Development 1 Matthew J. Hardman and Carolyn Byrne 2. Microbiology 21 Robert Sidbury and Gary L. Darmstadt 3. Acid Mantle 47 Theodora M. Mauro and Martin J. Behne 4. Sebaceous Glands 59 Christos C. Zouboulis, Sabine Fimmel, Jana Ortmann, Julia R. Turnbull, and Anett Boschnakow 5. Neonatal Pigmentation 89 Howard Fein and James J. Nordlund 6. Eccrine Sweating in the Newborn 109 Nicholas Rutter 7. The Cutaneous Vasculature in Normal and Wounded Neonatal Skin 125 Terence J. Ryan vii viii Contents Special Issues 8. Prematurity 153 Steven B. Hoath and Nicholas Rutter 9. Electrical Properties of Newborn Skin 179 Hachiro Tagami, Katsuko Kikuchi, Hiromi Kobayashi, and Kenichiro O’goshi 10. The Biology of Vernix 193 Steven B. Hoath and William L. Pickens 11. Bathing the Term Newborn: Personal Cleanser Considerations 211 Keith D. Ertel 12. Aesthetics of Newborn Skin: Biophysical Aspects 239 Ge´rald E. Pie´rard, Philippe Paquet, and Claudine Pie´rard-Franchimont 13. Transepidermal Water Loss 253 Gunnar Sedin 14. Percutaneous Penetration 285 Iryna Kravchenko and Howard I. Maibach 15. Adhesion and Newborn Skin 299 Carolyn Houska Lund and Joseph A. Tucker 16. Environmental Interactions 325 Marty O. Visscher Index 367 Contributors Martin J. Behne, M.D. Assistant Researcher, Department of Derma- tology, University of California, San Francisco, School of Medicine, San Francisco, California, U.S.A. Anett Boschnakow, Dr. med. Department of Dermatology, University Medical Center Benjamin Franklin, The Free University of Berlin, Berlin, Germany Carolyn Byrne, Ph.D. School of Biological Sciences, University of Manchester, Manchester, England Gary L. Darmstadt, M.D. Senior Research Adviser, Office of Health, Save the Children Federation–USA, Washington, D.C., and Assistant Professor, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, U.S.A. Keith D. Ertel, Ph.D. Principal Scientist, Procter & Gamble Beauty Science, Cincinnati, Ohio, U.S.A. Howard Fein, M.D. Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, U.S.A. Sabine Fimmel, Dr. rer. nat. Department of Dermatology, University Medical Center Benjamin Franklin, The Free University of Berlin, Berlin, Germany ix x Contributors Matthew J. Hardman, Ph.D. School of Biological Sciences, University of Manchester, Manchester, England Steven B. Hoath, M.D. Professor, Division of Neonatology, Department of Pediatrics, University of Cincinnati College of Medicine, and Medical Director, Skin Sciences Institute, Children’s Hospital Research Foundation, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A. Katsuko Kikuchi Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan Hiromi Kobayashi, M.D. Department of Dermatology, Japanese Der- matological Association, Sendai, Japan Iryna Kravchenko, Ph.D. Associate Professor, Department of Phar- maceutical Chemistry, Odessa National University, Odessa, Ukraine Carolyn Houska Lund, R.N., M.S., F.A.A.N. Neonatal Clinical